Project Summary/Abstract Up to 350,000 patients in the US experience clinically significant depressed mood post-ACS per year. Post-ACS depression predicts high rates of morbidity and mortality. At least part of the relationship between depressed mood and post-ACS morbidity/mortality is explained by a poor profile of modifiable behavioral risk factors (i.e., smoking, physical activity, medication adherence, diet) among those with depression, suggesting that depressed mood contributes to morbidity/mortality through interference with post-ACS improvement in behavioral risk factors. Thus, a single, integrated treatment that targets both depressed mood and multiple behavioral risk factors could be highly effective in reducing post-ACS mortality. Behavioral Activation for depression may be an ideal counseling treatment for this integration because it is easy to train, can be delivered by Bachelor's level practitioners, and has recently shown promise for facilitating behavioral risk factor changes in other medical populations with depression. Dr. Busch is currently completing an NHLBI K23 award (K23HL107391) that developed and tested an integrated manual that targets post-ACS depressed mood and smoking cessation. The current application proposes to adapt this manual to target depression and multiple behavioral risk factors post-ACS. Aim I: Refine the PI's previously developed treatment manual to target depressed mood and multiple behavioral risk factors post-ACS (Behavioral Activation for Health and Depression; BA-HD) using individual qualitative interviews (N ? 10-15) with patients with depressed mood who have struggled with two or more behavioral risk factors following ACS. Aim II: Conduct an open trial (N=20) of BA-HD to test the feasibility and acceptability of our procedures and obtain initial indications of efficacy. We hypothesize that 1) the BA-HD manual and study procedures will be feasible and acceptable to post-ACS patients with depressed mood as measured by self-report, recruitment/retention rate, and post- treatment qualitative interviews and 2) that participants will experience clinically significant improvements in depressed mood and behavioral risk factor profile. Public Health Impact: The proposed study is an initial step to address significant morbidity/mortality disparities experienced by post-ACS patients with depression. The long-term goal of this line of research is to improve long-term survival rates following ACS.